The overall purpose of this three-part Competitive Renewal Proposal is to determine whether established measures for secondary prevention of cardiovascular disease can be incorporated into the clinical practice of coronary artery bypass graft surgery (CABG). This proposal will build upon the operational infrastructure for CQI in CABG developed by the Society of Thoracic Surgeons, its National Cardiac Database and its partnership with the Duke Clinical Research Institute, during the first award interval. The Specific Aims of this first award have essentially been achieved, and this Medical Specialty Society-based CQI platform has been documented to positively influence CQI in CABG on a national level. Using a RCT design, we will first determine whether our initial CQI efforts in surgery are sustainable and translate into durable changes in national care practices, second, assess whether this surgical CQ1 platform can be extended to address secondary prevention, in order to impact on the long-term hazard phase of CABG, and third develop and disseminate a Web-based information tool for promoting long-term patient compliance with secondary prevention. The Specific Aims of this renewal are: 1. To determine whether ongoing QI intervention and performance feedback is necessary to sustain site improvements in targeted care processes, 2. To evaluate whether surgical CQI activities at sites can be extended to secondary prevention, 3. Conduct a demonstration project that uses an innovative web-based patient education tool for promoting long-term patient compliance following CABG and provide pilot data. In sum, this Competitive Renewal intends to take a unique, successful professional society-led CQI platform to the next level, and by doing so continue to set a standard for other areas of medicine.